Winona’s State of Menopause 2026 report reframes menopause as a layered health burden involving cognitive disruption, fatigue, sleep issues, delayed care, GSM concerns, and long-term health worries

Austin, Texas — June 23, 2026 — (PR Newswire) — A new analysis of more than 100,000 menopause patient intake assessments suggests that the way menopause is commonly discussed may be too narrow. While hot flashes remain one of the most recognizable symptoms, Winona’s State of Menopause 2026 Report found that women seeking care report an average of nine symptoms at once, with energy loss, fatigue, brain fog, sleep issues, weight changes, emotional symptoms, GSM-related concerns, and future health worries appearing across the patient experience.

The report, released by Winona, a physician-led telehealth company focused on menopause and perimenopause care, analyzes proprietary, de-identified patient intake assessments and patient profiles collected between May 1, 2025, and February 28, 2026. The findings should be interpreted as a real-world patient-care dataset rather than a nationally representative survey.

The report points to a broader picture of menopause as it is experienced by women seeking care: layered symptoms, delayed treatment, cognitive and daily-life disruption, intimacy and GSM concerns, and growing attention to long-term cognitive, bone, urinary, vaginal, and heart health.

Across women ages 35–60, patients report an average of nine concurrent menopause symptoms, with the maximum reported symptom load reaching 16. Three in four women report living with six or more symptoms at once, and more than one in three carry a severe burden of 10 or more symptoms simultaneously.

The most commonly reported symptoms include energy loss, weight changes, fatigue, brain fog, sleep issues, and hot flashes. Energy loss is cited by 79% of patients, followed by weight gain at 75%, fatigue at 71%, brain fog at nearly 70%, sleep issues at 69%, and hot flashes at 44%.

“An average of nine symptoms points to something broader than a single view of menopause. Hormonal changes tend to affect multiple systems, not just cause isolated issues.”
— Dr. Cathleen M. Brown, DO, Medical Director, Winona

• Women report an average of 9 symptoms at once

• 76% report 6 or more symptoms simultaneously

• 36% report 10 or more symptoms simultaneously

• 79% report energy loss

• 75% report weight gain

• 71% report fatigue

• Nearly 70% report brain fog

• 69% report sleep issues

• 44% report hot flashes

• 56% fall into a brain fog and fatigue burden pattern

• 77.5% report living with symptoms for at least one year before finding care

• 71% experience a GSM symptom burden

The report found that cognitive and energy-related symptoms are among the most common and interconnected parts of the menopause experience. Brain fog affects nearly 70% of women in the dataset, while 57% fall into a combined brain fog and fatigue burden pattern. Among women reporting brain fog, 86% also report low energy.

These findings suggest that menopause is not only felt physically. It can also affect focus, memory, mental clarity, energy, sleep, emotional strain, and daily functioning.

One of the report’s most notable findings is the delay in care-seeking. More than three in four women report living with menopause symptoms for at least one year before finding care, and most report a one-to-three-year gap between symptom onset and treatment.

Women with prior hormone therapy use are twice as likely to have lived with symptoms for more than three years, suggesting that many patients reaching care are not new to menopause symptoms, but are instead carrying a more prolonged and complex symptom burden.

Relief from menopause symptoms is not always found on the first attempt. Many of our patients come to us after trying other approaches that didn’t fully address what they were experiencing.

Dr. Michael Green MD, Chief Medical Officer

“Relief from menopause symptoms is not always found on the first attempt. Many of our patients come to us after trying other approaches that didn’t fully address what they were experiencing.”
— Dr. Michael Green, MD, Chief Medical Officer, Winona

The report also found that menopause symptoms often cluster in ways that affect daily life. Sleep disruption is reported by 69% of women, and those with sleep issues disproportionately also report fatigue and brain fog. Among women reporting sleep issues, 76% also report fatigue and 73% also report brain fog.

The report also found a meaningful cognitive-emotional burden pattern, with 40% of women experiencing a cluster of brain fog, fatigue, and anxiety. GSM and intimacy-related symptoms are also common, with 71% experiencing a GSM symptom burden and nearly one in three falling into an intimacy disruption cluster.

“Relief is not just about reducing menopause symptoms. In this context, relief has to restore how a woman functions day to day.”
— Dr. Cathleen M. Brown, DO, Medical Director, Winona

The report suggests that women are seeking care not only for symptom relief, but also for long-term health preservation. Cognitive changes are the leading future health concern among patients, accounting for 35% of reported future health concerns. Bone health, urinary concerns, vaginal atrophy, and heart health also appear among the top concerns.

These findings broaden the definition of menopause relief beyond symptom control alone. For many women, relief also means protecting daily function, maintaining long-term health, and receiving care that adapts as symptoms and concerns change over time.

“Menopause is not only defined by symptoms. It also shapes long-term health in ways that aren’t immediately visible.”
— Dr. Michael Green, MD, Chief Medical Officer, Winona

When it comes to how women want to receive care, treatment preferences are concentrated around a small number of formats. Pills are preferred by 67.5% of patients, followed by creams at 25.8% and patches at 6.5%.

Among women with prior hormone therapy experience, treatment engagement is higher and concerns are more defined, reflecting a patient population often further along in the care journey and managing a more complex set of needs.

The State of Menopause 2026 report is based on proprietary, de-identified patient data collected through Winona’s intake assessments and patient profiles between May 1, 2025, and February 28, 2026. The dataset includes more than 100,000 completed assessments and patient profiles.

The report was developed with clinical oversight from Winona’s medical leadership, including Chief Medical Officer Dr. Michael Green, MD, and Medical Director Dr. Cathleen M. Brown, DO.

The full report is available at https://bywinona.com/resources/state-of-menopause.